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Morales-Concha L, Huamani-Linares I, Saihua-Palomino K, Luque Florez E, Chávez Echevarría A, Tupayachi Palomino RJ, Zea Nuñez CA, Mejia CR, Atamari-Anahui N. Characteristics and survival of adults with differentiated thyroid cancer in a Peruvian hospital. Rev Peru Med Exp Salud Publica 2024; 41:287-293. [PMID: 39442111 PMCID: PMC11495931 DOI: 10.17843/rpmesp.2024.413.13378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 05/29/2024] [Indexed: 10/25/2024] Open
Abstract
BACKGROUND Motivation for the study. There are few clinical and survival studies in Peru on thyroid cancer. BACKGROUND Main findings. Between the years 2010 to 2020, differentiated thyroid cancer was more frequent in women with early-stage disease, but survival was lower at five years compared to reports from other countries. BACKGROUND Implications. Thyroid cancer has increased in recent decades worldwide. It is important to have specialized and decentralized centers for the initial management and follow-up of these patients to avoid long-term complications or fatal outcomes and to have updated epidemiological information. BACKGROUND This study aimed at studying the clinical and anatomopathological characteristics, treatment and survival of patients with differentiated thyroid cancer. A retrospective cohort study was conducted with data from 150 patients from a Peruvian hospital between the years 2010 to 2020. Characteristics and survival (Kaplan-Meier method) were described. The mean age was 48.3 years, 130 participants (86.7%) were women and the most frequent histologic type was papillary 94.6%. Of the participants, 74.2% had TNM stage I, 70.7% had total thyroidectomy and 68.7% received radioactive iodine. Overall survival at 5 years was 89.3%, being lower in those with TNM stage IV and higher in those who used radioactive iodine. In conclusion, in a hospital in Cusco, differentiated thyroid cancer was more frequent in women and survival was lower compared to reports from other countries.
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Affiliation(s)
- Luz Morales-Concha
- Faculty of Human Medicine, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru.Universidad Nacional San Antonio Abad del CuscoFaculty of Human MedicineUniversidad Nacional de San Antonio Abad del CuscoCuscoPeru
| | - Iván Huamani-Linares
- Faculty of Human Medicine, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru.Universidad Nacional San Antonio Abad del CuscoFaculty of Human MedicineUniversidad Nacional de San Antonio Abad del CuscoCuscoPeru
- ASOCIEMH-CUSCO, Faculty of Human Medicine, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru.Universidad Nacional San Antonio Abad del CuscoASOCIEMH-CUFaculty of Human MedicineUniversidad Nacional de San Antonio Abad del CuscoCuscoPeru
| | - Katy Saihua-Palomino
- Faculty of Human Medicine, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru.Universidad Nacional San Antonio Abad del CuscoFaculty of Human MedicineUniversidad Nacional de San Antonio Abad del CuscoCuscoPeru
- ASOCIEMH-CUSCO, Faculty of Human Medicine, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru.Universidad Nacional San Antonio Abad del CuscoASOCIEMH-CUFaculty of Human MedicineUniversidad Nacional de San Antonio Abad del CuscoCuscoPeru
| | - Edward Luque Florez
- Faculty of Human Medicine, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru.Universidad Nacional San Antonio Abad del CuscoFaculty of Human MedicineUniversidad Nacional de San Antonio Abad del CuscoCuscoPeru
- Department of General Surgery, Hospital Antonio Lorena, Cusco, Peru.Department of General SurgeryHospital Antonio LorenaCuscoPeru
| | - Alexi Chávez Echevarría
- Faculty of Human Medicine, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru.Universidad Nacional San Antonio Abad del CuscoFaculty of Human MedicineUniversidad Nacional de San Antonio Abad del CuscoCuscoPeru
- Adolfo Guevara Velasco National Hospital - EsSalud, Cusco, Peru.Adolfo Guevara Velasco National Hospital - EsSaludCuscoPeru
| | - Ramiro Jorge Tupayachi Palomino
- Faculty of Human Medicine, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru.Universidad Nacional San Antonio Abad del CuscoFaculty of Human MedicineUniversidad Nacional de San Antonio Abad del CuscoCuscoPeru
- Adolfo Guevara Velasco National Hospital - EsSalud, Cusco, Peru.Adolfo Guevara Velasco National Hospital - EsSaludCuscoPeru
| | - Carlos Antonio Zea Nuñez
- Faculty of Human Medicine, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru.Universidad Nacional San Antonio Abad del CuscoFaculty of Human MedicineUniversidad Nacional de San Antonio Abad del CuscoCuscoPeru
- Adolfo Guevara Velasco National Hospital - EsSalud, Cusco, Peru.Adolfo Guevara Velasco National Hospital - EsSaludCuscoPeru
| | - Christian R. Mejia
- Universidad Continental, Huancayo, Peru.Universidad ContinentalHuancayoPeru
- Medical Association of Research and Health Services, Lima, Peru.Medical Association of Research and Health ServicesLimaPeru
| | - Noé Atamari-Anahui
- Research Unit for the Generation and Synthesis of Health Evidence, Vice Rectorate for Research, San Ignacio de Loyola University, Lima, Peru. San Ignacio de Loyola UniversityResearch Unit for the Generation and Synthesis of Health EvidenceVice Rectorate for ResearchSan Ignacio de Loyola UniversityLimaPeru
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Lampert-Okin SL. The Not-So-Good Cancer: Psychosocial Challenges for YA Thyroid Cancer Patients and Survivors and the Creation of a YA Thyroid Cancer Support Group. J Adolesc Young Adult Oncol 2024; 13:723-725. [PMID: 38682360 DOI: 10.1089/jayao.2024.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
Thyroid cancer (TC) has been deemed "the good cancer" owing to its slow growth, availability of targeted treatment, and low mortality rates. Inconsistent with this name, survivors of TC have similar or poorer quality of life than individuals with other types of cancer. Furthermore, young adults (YAs; age 18-35) with TC are at risk for additional psychosocial challenges. Support groups have been identified as a mechanism for improving quality of life among other YAs with cancer. A YA TC group is warranted given the unique experiences of TC survivors. Discussion points from a newly developed YA TC support group are reviewed.
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Affiliation(s)
- Sara L Lampert-Okin
- Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
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Wang Q, Yu B, Zhang S, Wang D, Xiao Z, Meng H, Dong L, Zhang Y, Wu J, Hou Z, Zhu Y, Li D. Papillary Thyroid Carcinoma: Correlation Between Molecular and Clinical Features. Mol Diagn Ther 2024; 28:601-609. [PMID: 38896179 PMCID: PMC11349796 DOI: 10.1007/s40291-024-00721-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Thyroid cancer is prevalent worldwide, including in China, where its incidence is on the rise. Papillary thyroid carcinoma (PTC) is the predominant subtype. Investigating the relationship between clinical data associated with PTC and gene mutations is crucial for improving detection and treatment. PATIENTS AND METHODS We collected samples and associated clinical data from 700 PTC patients at Shanxi Provincial People's Hospital. Using a panel of 57 genes linked to thyroid cancer, we sequenced the samples to determine the mutation frequency of thyroid cancer-associated genes in PTC. We further analyzed the correlation between gene variants and clinical information. RESULTS The mean age of patients in this study was 42.5 years. Females predominated, comprising 507 of the total patient population, resulting in a female-to-male ratio of 2.63 (507:193). Tumor distribution revealed 198, 257, and 142 cases on the left, right, and both sides, respectively. Among the 57 thyroid cancer-related genes analyzed, we identified at least one driver gene in 83.6% of patients. Notably, 76.4% had BRAF mutations, mainly BRAFV600E, which constituted 90.9% of all BRAF mutations, with 535 cases exhibiting these mutations. Other significant driver genes included CHEK2 (n = 84), RET (n = 42), PIK3CA (n = 7), and EGFR (n = 7). RET fusions (n = 28) were also identified. Notably, patients under 55 years old exhibit a higher tendency towards advanced N staging, suggesting that younger individuals may be more prone to lymph node metastasis. Additionally, male patients were more likely to have advanced N stages. Importantly, a positive correlation was observed between higher BRAF allele frequencies and more advanced T and N stages. Similarly, correlation analysis revealed that a greater frequency of RET fusions correlated with later T and N stages. CONCLUSION This study uncovered several significant insights. Younger PTC patients exhibited a higher propensity for lymph node metastasis. An elevated mutation frequency of BRAF was correlated with a higher occurrence of RET fusions, predisposing individuals to lymph node metastasis and potentially indicating a poorer prognosis.
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Affiliation(s)
- Qiang Wang
- Department of Thyroid Surgery, Shanxi Provincial People's Hospital, No. 29, Shuangta East Street, Yingze District, Taiyuan, 030012, Shanxi, China
| | - Bo Yu
- Department of Medicine, Beijing USCI Medical Laboratory, Beijing, 100195, China
| | - Shuilong Zhang
- Department of Thyroid Surgery, Shanxi Provincial People's Hospital, No. 29, Shuangta East Street, Yingze District, Taiyuan, 030012, Shanxi, China
| | - Dongliang Wang
- Department of Thyroid Surgery, Shanxi Provincial People's Hospital, No. 29, Shuangta East Street, Yingze District, Taiyuan, 030012, Shanxi, China
| | - Zhifu Xiao
- Department of Thyroid Surgery, Shanxi Provincial People's Hospital, No. 29, Shuangta East Street, Yingze District, Taiyuan, 030012, Shanxi, China
| | - Hongjing Meng
- Department of Thyroid Surgery, Shanxi Provincial People's Hospital, No. 29, Shuangta East Street, Yingze District, Taiyuan, 030012, Shanxi, China
| | - Lingxiang Dong
- Department of Thyroid Surgery, Shanxi Provincial People's Hospital, No. 29, Shuangta East Street, Yingze District, Taiyuan, 030012, Shanxi, China
| | - Yuhang Zhang
- Department of Thyroid Surgery, Shanxi Provincial People's Hospital, No. 29, Shuangta East Street, Yingze District, Taiyuan, 030012, Shanxi, China
| | - Jie Wu
- Department of Thyroid Surgery, Shanxi Provincial People's Hospital, No. 29, Shuangta East Street, Yingze District, Taiyuan, 030012, Shanxi, China
| | - Zebin Hou
- Department of Thyroid Surgery, Shanxi Provincial People's Hospital, No. 29, Shuangta East Street, Yingze District, Taiyuan, 030012, Shanxi, China
| | - Yunji Zhu
- Department of Medicine, Beijing USCI Medical Laboratory, Beijing, 100195, China
| | - Dewei Li
- Department of Thyroid Surgery, Shanxi Provincial People's Hospital, No. 29, Shuangta East Street, Yingze District, Taiyuan, 030012, Shanxi, China.
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Baek HS, Ha J, Kim K, Bae JS, Kim JS, Kim S, Lim DJ, Kim CM. Cost-Utility Analysis of Early Detection with Ultrasonography of Differentiated Thyroid Cancer: A Retrospective Study on a Korean Population. Endocrinol Metab (Seoul) 2024; 39:310-323. [PMID: 38590123 PMCID: PMC11066449 DOI: 10.3803/enm.2023.1870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGRUOUND There is debate about ultrasonography screening for thyroid cancer and its cost-effectiveness. This study aimed to evaluate the cost-effectiveness of early screening (ES) versus symptomatic detection (SD) for differentiated thyroid cancer (DTC) in Korea. METHODS A Markov decision analysis model was constructed to compare the cost-effectiveness of ES and SD. The model considered direct medical costs, health outcomes, and different diagnostic and treatment pathways. Input data were derived from literature and Korean population studies. Incremental cost-effectiveness ratio (ICER) was calculated. Willingness-to-pay (WTP) threshold was set at USD 100,000 or 20,000 per quality-adjusted life year (QALY) gained. Sensitivity analyses were conducted to address uncertainties of the model's variables. RESULTS In a base case scenario with 50 years of follow-up, ES was found to be cost-effective compared to SD, with an ICER of $2,852 per QALY. With WTP set at $100,000, in the case with follow-up less than 10 years, the SD was cost-effective. Sensitivity analysis showed that variables such as lobectomy probability, age, mortality, and utility scores significantly influenced the ICER. Despite variations in costs and other factors, all ICER values remained below the WTP threshold. CONCLUSION Findings of this study indicate that ES is a cost-effective strategy for DTC screening in the Korean medical system. Early detection and subsequent lobectomy contribute to the cost-effectiveness of ES, while SD at an advanced stage makes ES more cost-effective. Expected follow-up duration should be considered to determine an optimal strategy for DTC screening.
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Affiliation(s)
- Han-Sang Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Jeonghoon Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kwangsoon Kim
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ja Seong Bae
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Soo Kim
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sungju Kim
- Healthcare Group, Lee & Ko, Seoul, Korea
| | - Dong-Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul-Min Kim
- Department of Family Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Sun H, Zhao X, Wang X, Ma J, Liu M. Correlation analysis of risk factors for cervical lymphatic metastasis in papillary thyroid carcinoma. Diagn Pathol 2024; 19:13. [PMID: 38218832 PMCID: PMC10788004 DOI: 10.1186/s13000-024-01440-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 01/07/2024] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVE This study aims to identify and analyze the risk factors associated with Cervical Lymph Node Metastasis (CNM) in Papillary Thyroid Carcinoma (PTC) patients. METHODS We conducted a retrospective study involving the clinicopathological data of 2384 PTC patients admitted to our hospital between January 2016 and December 2020. All relevant data were statistically processed and analyzed. RESULTS The related risk factors for Central Lymph Node Metastasis (CLNM) were gender (male), age (≤ 30 years old), tumor lesion size (> 0.855 cm), and multifocal tumor foci. The ROC curve revealed that the critical value for predicting CLNM based on tumor lesion size was 0.855 (sensitivity = 57.9%, specificity = 69%, AUC = 0.269, and P < 0.05). Lateral Lymph Node Metastasis (LLNM) was positively correlated with tumor diameter. Specifically, the LLNM rate increased with the tumor diameter. LLNM occurrence was significantly higher in zones II, III, and IV than in zones I and V. Although the BRAF gene mutation detection assay has certain clinical benefits in diagnosing PTC and LLNM, no statistically significant difference was found in its relationship with central and lateral neck lymph node metastases (P = 0.741). CONCLUSION Our findings revealed that CLNM is associated with gender (male), age (≤ 30 years old), tumor lesion size (> 0.855 cm), and multiple tumor lesions in PTC patients. Central Lymph Node Dissection (CLND) is recommended for patients with these risk factors. On the other hand, preoperative ultrasound examination, fine-needle pathological examination, and genetic testing should be used to determine whether Lateral Cervical Lymph Node Dissection (LLND) is needed.
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Affiliation(s)
- Haoying Sun
- Department of Thyroid and Breast Surgery, The Affiliated Hospital of Inner Mongolia Medical University, No. 1 Tongdaobei Street, Hohhot, Inner Mongolia, 010050, China
| | - Xueyu Zhao
- Department of Thyroid and Breast Surgery, The Affiliated Hospital of Inner Mongolia Medical University, No. 1 Tongdaobei Street, Hohhot, Inner Mongolia, 010050, China
| | - Xin Wang
- Inner Mongolia Cancer Hospital, Hohhot, China
| | - Jinzhu Ma
- Department of Thyroid and Breast Surgery, The Affiliated Hospital of Inner Mongolia Medical University, No. 1 Tongdaobei Street, Hohhot, Inner Mongolia, 010050, China
| | - Ming Liu
- Department of Thyroid and Breast Surgery, The Affiliated Hospital of Inner Mongolia Medical University, No. 1 Tongdaobei Street, Hohhot, Inner Mongolia, 010050, China.
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Wang H, Zhao S, Yao J, Yu X, Xu D. Factors influencing extrathyroidal extension of papillary thyroid cancer and evaluation of ultrasonography for its diagnosis: a retrospective analysis. Sci Rep 2023; 13:18344. [PMID: 37884592 PMCID: PMC10603168 DOI: 10.1038/s41598-023-45642-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/22/2023] [Indexed: 10/28/2023] Open
Abstract
Pathologists usually explore extrathyroidal extensions (ETEs) in thyroid cancer; however, sonographers are often not concerned with ETEs. We investigated factors influencing ETEs and the efficacy of ultrasound evaluation of thyroid capsule invasion. We retrospectively analysed 1933 papillary thyroid carcinoma patients who underwent thyroidectomy during 2018-2021. Patients were divided into three groups: no ETE, minor ETE (mETE), and gross ETE. Clinical characteristic differences were assessed using binary logistic regression analysis to identify ETE predictors, and the kappa test was performed to analyse consistency between ultrasonographic and pathological diagnoses of ETE. The mETE group was more likely to have larger tumour diameters and more extensive lymph node metastasis (LNM) than the no ETE group and more likely to be diagnosed in the isthmus. In the multivariate logistic regression analysis, longest tumour diameter, lesion site, LNM extent, and thyroglobulin concentration were significant mETE predictors. Minimal consistency existed between pathological and ultrasonographic examinations for neighbouring tissue invasion. Many clinical differences were observed between the no ETE and mETE groups, suggesting the importance of considering mETE. Therefore, sonographers should pay more attention to relationships between nodules and capsule and indicate these on ultrasound reports to provide more accurate preoperative ETE information for surgeons.
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Affiliation(s)
- Hui Wang
- Department of Ultrasound, Joint Service Support Force 903 Hospital, Hangzhou, China
| | - Shanshan Zhao
- Department of Ultrasound, Shaoxing People's Hospital, Shaoxing, China
| | - Jincao Yao
- Department of Ultrasound, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital); Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China
| | - Xiuhua Yu
- Department of Ultrasound, Joint Service Support Force 903 Hospital, Hangzhou, China.
| | - Dong Xu
- Department of Ultrasound, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital); Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Key Laboratory of Head & Neck Cancer Translational Research of Zhejiang Province, Hangzhou, China.
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7
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Wu ZJ, Xia BY, Chen ZW, Gong H, Abuduwaili M, Xing ZC, Su AP. The value of total tumor diameter in unilateral multifocal papillary thyroid carcinoma: a propensity score matching analysis. Front Endocrinol (Lausanne) 2023; 14:1217613. [PMID: 37745721 PMCID: PMC10511886 DOI: 10.3389/fendo.2023.1217613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023] Open
Abstract
Background Tumor multifocality is frequently observed in papillary thyroid carcinoma (PTC). However, the maximum tumor diameter (MTD), currently utilized in various staging schemes, might not accurately indicate the level of aggressiveness exhibited by multifocal tumors. We aimed to investigate the relationship between total tumor diameter (TTD) and clinicopathological features of papillary thyroid carcinoma. Methods Retrospective data analysis was done on 1936 individuals who underwent complete thyroidectomy for PTC. Patients were classified into subgroups according to unilateral multifocality, central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM). The relationships of clinicopathological features among these groups were analyzed. Results Unilateral multifocality was observed in 117 patients. The clinicopathological features of the unilateral multifocal PTC were similar to the unifocal PTC with approximate TTD. The unilateral multifocality played no independent role in CLNM and LLNM. Moreover, the efficiency of TTD in predicting CLNM and LLNM was significantly higher than that of MTD. Conclusion In the case of unilateral multifocal PTC, TTD is a more accurate indicator of the biological characteristics of the tumor than MTD.
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Affiliation(s)
- Zhu-juan Wu
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bao-ying Xia
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zi-wei Chen
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Gong
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Munire Abuduwaili
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Zhi-chao Xing
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - An-ping Su
- Department of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, China
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Koot A, Hermens R, Ottevanger P, Netea-Maier R, Stalmeier P. Patient decision aids for patients with differentiated thyroid carcinoma: development process and alpha and beta testing. Front Endocrinol (Lausanne) 2023; 14:1162537. [PMID: 37324263 PMCID: PMC10264809 DOI: 10.3389/fendo.2023.1162537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/16/2023] [Indexed: 06/17/2023] Open
Abstract
Background Patient decision aids (PtDAs) are structured clinical tools that facilitate shared decision-making. Two important treatment decisions for patients with differentiated thyroid cancer (DTC), which could benefit from PtDAs, are as follows (1): the extent of surgery decision in patients with low-risk DTC and (2) the decision to start or delay starting the treatment with tyrosine kinase inhibitors (TKIs) in patients with advanced tumors. Material and methods PtDAs for these two decisions were developed using the International Patient Decision Aids Standards (IPDAS) quality criteria in an iterative process of prototype development via alpha and beta testing by patients and physicians. The information content of the PtDAs was based on the available literature, current guidelines, and patient's needs, preferences, and values. Results The web-based PtDAs underwent two rounds of alpha testing, revisions, and beta testing. The PtDAs have the same structure, consisting of six steps: a general introduction, information about the treatment options, comparing the treatment options, knowledge questions, a values clarification exercise, and saving the information. The alpha testing (n = 8 patients, n = 10 physicians) showed that the PtDAs were highly acceptable and usable for decision-making. Results of the beta testing in 20 patients showed that two patients did not use the PtDA; the other 18 patients found that the PtDAs were readable (n = 17) and helpful (n = 14) for decision-making. All patients recommend using the PtDAs. Conclusions Evidence-based PtDAs were created for patients with DTC for two different treatment decisions. Our final version was judged to be clear, balanced, and helpful in decision-making.
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Affiliation(s)
- Anna Koot
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rosella Hermens
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, Netherlands
| | - Petronella Ottevanger
- Department of Internal Medicine, Division of Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Romana Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Peep Stalmeier
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
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Cho S, Kim H, Oh YL, Hahn SY, Kim TH, Shin JH. Comparison of clinicopathological characteristics and survival between symptomatic and asymptomatic anaplastic thyroid carcinoma. Sci Rep 2023; 13:3264. [PMID: 36828842 PMCID: PMC9957983 DOI: 10.1038/s41598-023-30162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/16/2023] [Indexed: 02/26/2023] Open
Abstract
Although anaplastic thyroid carcinoma (ATC) is a fatal form of thyroid cancer with an overall survival of only a few months, there are some factors associated with longer survival. However, it remains unknown whether asymptomatic ATC differs from symptomatic ATC in terms of characteristics and overall prognosis. Therefore, we aimed to examine the clinicopathological characteristics and prognosis of asymptomatic ATC compared with those of symptomatic ATC. We retrospectively reviewed the medical records of 113 patients with ATC who were registered at our institution between November 1994 and July 2020. A total of 86 patients (59 women and 27 men; mean age, 66.9 ± 11.1 years) were enrolled for analysis. The clinicopathological characteristics of the ATC cohort were evaluated, and prognostic factors associated with disease-specific mortality were assessed. Of the 86 patients with ATC, 78 were symptomatic and eight were asymptomatic. Compared with the symptomatic group, the asymptomatic group had a younger age at diagnosis (59.3 ± 10.3 vs. 67.7 ± 11.0 years, p = 0.045), smaller tumor size (2.8 ± 1.2 vs. 5.8 ± 2.0 cm, p < 0.001), and longer survival period (37.5 ± 46.4, 9.5 ± 16.8 months, p < 0.001). However, the ATC component (%) of the tumor, sex, ultrasonographic risk category, and distant metastasis at diagnosis did not differ significantly between the two groups. In the multivariate Cox regression analysis, asymptomatic ATC (HR: 0.33, 95% CI 0.11-0.99, p = 0.045) and absence of distant metastasis (hazard ratio (HR): 0.56, 95% Confidence interval (CI) 0.35-0.88, p = 0.012) were associated with longer survival. Patients with asymptomatic ATC have a smaller tumor size, a longer survival period, and a younger age than those with symptomatic ATC. Being asymptomatic and having no distant metastasis were associated with longer survival in patients with ATC in a clinical setting.
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Affiliation(s)
- Seomin Cho
- Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Haejung Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Young Lyun Oh
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo Yeon Hahn
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Tae Hyuk Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Hee Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Fang Y, Zheng X, Zou X, Ye Z, Liu J, Lei J, Li Z. Genetic and clinical profiles of 160 papillary thyroid cancers with lateral neck lymph node metastasis. Front Oncol 2023; 12:1057532. [PMID: 36713542 PMCID: PMC9877400 DOI: 10.3389/fonc.2022.1057532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/19/2022] [Indexed: 01/14/2023] Open
Abstract
Background Lymph node metastasis is widespread in papillary thyroid cancer (PTC). Patients are more vulnerable than those with central lymph node metastasis if they have lateral neck lymph node metastasis (LLNM). There are few researches focus on the correlation between clinical characteristics and genetic profile of PTC with LLNM. In this study, we aimed to analyze the clinical and genetic features of PTC with LLNM. Methods A total of 160 primary tumor samples derived from PTC patients with LLNM were involved. Targeted next-generation sequencing was carried out on all samples with 57 known thyroid-cancer-related genes. The associations between genomic alternations and clinical characteristics of PTC with LLNM were statistically evaluated. Results The median age of patients was 37 years, ranging from 5 to 77 years and the female/male ratio was 1.86. The most frequently altered genes in our series were BRAF mutation (68%), followed by RET fusion (17%), TERT promoter mutation (5%) and PIK3CA mutation (2%). To be noted, all PTC patients with LLNM of TERT promoter mutations appeared along with BRAF mutations (8/8) and half of them experienced a relapse. Intriguingly, we found more metastatic lymph nodes in patients with RET fusion, but there was no statistically significant difference in metastatic lymph node ratio than those with BRAF mutation or without mutation. A high rate of gene fusion (70%) was found in the pediatric population, with aggressive late-onset disease. Conclusions PTC patients with LLNM is characterized by a high rate of BRAF mutation. Due to the observed clinicopathological differences in those patients among different alterations, further prospective studies are needed to verify our results and to evaluate the most suitable treatment strategies.
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Affiliation(s)
- Yiqiao Fang
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China,Laboratory of Thyroid and Parathyroid Diseases, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xun Zheng
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China,Laboratory of Thyroid and Parathyroid Diseases, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiuhe Zou
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China,Laboratory of Thyroid and Parathyroid Diseases, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zi Ye
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiaye Liu
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China,Laboratory of Thyroid and Parathyroid Diseases, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China,State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, Sichuan, China,Respiratory Health Institute, Frontiers Science Center for Disease Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jianyong Lei
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China,Laboratory of Thyroid and Parathyroid Diseases, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhihui Li
- Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China,Laboratory of Thyroid and Parathyroid Diseases, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China,*Correspondence: Zhihui Li,
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11
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Wang X, Xu F, Gao J, Agyekum EA, Sun H, Zhang G, Li X, Xiang H, Hu S, Qian X. Differential diagnosis of diffuse sclerotic thyroid papillary carcinoma and Hashimoto's thyroiditis using fine-needle aspiration cytology, BRAF V600E , and ultrasound elastography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:942-950. [PMID: 35779272 PMCID: PMC9541506 DOI: 10.1002/jcu.23260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 05/07/2023]
Abstract
BACKGROUND The diffuse sclerosing variant of papillary thyroid carcinoma (DSV-PTC) has ultrasound findings that are similar to Hashimoto's thyroiditis (HT), resulting in under-diagnosis. DSV-PTC combined with HT is also common, so early and accurate diagnosis of DSV-PTC using a variety of diagnostic techniques, including FNAC, BRAFV600E mutation detection, and ultrasound elastography, is critical. OBJECTIVE To assess the diagnostic value of fine-needle aspiration cytology (FNAC) and BRAFV600E detection in combination with ultrasound elastography in the diagnosis of DSV-PTC. METHODS We performed a retrospective analysis of 40 patients with pathologically confirmed DSV-PTC and 43 patients with HT admitted to our hospital's ultrasound department between January 2015 and December 2020. Preoperative FNAC, BRAFV600E mutation detection, and ultrasound elastography imaging were all performed on all patients. For a definitive diagnosis, the results of these tests were compared to postoperative pathological findings. The diagnostic value of FNAC, BRAFV600E mutation detection, ultrasound elasticity imaging, and their combination for DSV-PTC diagnosis was assessed. RESULTS The mean elastic strain rate ratio (E1/E2) of the 40 DSV-PTC cases was 5.75 ± 2.14, while that of the 43 HT cases was 2.81 ± 1.20. The receiver operating characteristic (ROC) curve was generated using the average value of E2/E1. The area under the ROC curve was 0.910, and the optimal E2/E1 cut-off value was 4.500. When FNAC, BRAFV600E mutation detection, and ultrasound elasticity imaging detection were combined, the diagnostic sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of DSV-PTC diagnosis were 92.5%, 95.3%, 93.2%, 94.9%, and 94.0%, respectively, which were significantly higher than the single technique (p < 0.05). CONCLUSIONS The use of FNAC, BRAFV600E mutation detection, and ultrasound elastography in combination is more helpful in establishing an accurate diagnosis of DSV-PTC than using a single diagnostic technique alone.
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Affiliation(s)
- Xian Wang
- Department of UltrasoundAffiliated People's Hospital of Jiangsu UniversityZhenjiangChina
| | - Feiju Xu
- Department of UltrasoundAffiliated People's Hospital of Jiangsu UniversityZhenjiangChina
| | - Juan Gao
- Department of UltrasoundAffiliated People's Hospital of Jiangsu UniversityZhenjiangChina
| | | | - Hui Sun
- Department of PathologyAffiliated People's Hospital of Jiangsu UniversityZhenjiangChina
| | - Guoliang Zhang
- Department of General SurgeryAffiliated People's Hospital of Jiangsu UniversityZhenjiangChina
| | - Xinxin Li
- Department of Otolaryngology head and Neck SurgeryAffiliated People's Hospital of Jiangsu UniversityZhenjiangChina
| | - Hong Xiang
- Department of PediatricAffiliated Hospital of Jiangsu UniversityZhenjiangChina
| | - Shudong Hu
- Department of RadiologyAffiliated Hospital, Jiangnan UniversityWuxiChina
| | - Xiaoqin Qian
- Department of UltrasoundAffiliated People's Hospital of Jiangsu UniversityZhenjiangChina
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12
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Chooi JE, Ravindiran A, Balasubramanian SP. The influence of incidental detection of thyroid nodule on thyroid cancer risk and prognosis-A systematic review. Clin Endocrinol (Oxf) 2022; 96:246-254. [PMID: 34378225 DOI: 10.1111/cen.14575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Clinically inapparent thyroid nodules discovered serendipitously on imaging for nonthyroid indications are termed as thyroid incidentalomas. It is unclear whether these incidentalomas have a lower prevalence of malignancy or slower tumour progression compared to symptomatic nodules. The aims of this systematic review were to determine the impact of incidental detection of thyroid nodules on both the risk of malignancy and on prognosis in patients with thyroid cancer. METHOD PubMed and MEDLINE® on Web of Science databases were searched from inception to March 2020 for English language articles reporting on human studies of thyroid cancer risk and/or prognosis in incidental and nonincidental nodules. RESULTS Eighteen observational studies published between 1998 and 2020 were eligible for analysis; four studies reported on risk, nine on prognosis and five studies reported on both risk and prognosis. When comparing the incidental and nonincidental groups in the risk study, the odds of incidental detection in the cancer and benign groups ranged from 0.16 to 0.5 and 0.06 to 0.38, respectively (odds ratio [OR] = 0.64-2.86) in case-control studies (n = 6); the risk of malignancy for thyroid nodules ranged from 4% to 23.5% in the incidental and 3.8% to 28.7% in the nonincidental groups (relative risk = 0.13-6.27) in the cohort studies (n = 3). A meta-analysis of the eligible case-control studies (n = 3) showed a nonsignificant summated OR of 1.04 (95% confidence interval = 0.63-1.70; p = .88). In the prognosis study, five direct and thirteen indirect markers of prognosis were compared between the incidental and nonincidental groups. A meta-analysis was not possible but incidentally detected thyroid cancer had better progression-free and overall survival. CONCLUSION Current evidence suggests that investigation and management of thyroid nodules should not be influenced by the mode of detection.
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Affiliation(s)
- Je Ern Chooi
- The Medical School, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, South Yorkshire, UK
- Department of Oncology and Metabolism, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Abiramie Ravindiran
- The Medical School, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, South Yorkshire, UK
| | - Saba P Balasubramanian
- Department of Oncology and Metabolism, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, South Yorkshire, UK
- Directorate of General Surgery, Sheffield Teaching Hospitals, Sheffield, South Yorkshire, UK
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13
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Koot A, Netea-Maier R, Ottevanger P, Hermens R, Stalmeier P. Needs, Preferences, and Values during Different Treatment Decisions of Patients with Differentiated Thyroid Cancer. J Pers Med 2021; 11:jpm11070682. [PMID: 34357149 PMCID: PMC8304194 DOI: 10.3390/jpm11070682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/09/2021] [Accepted: 07/15/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The purpose of this study was to identify the needs, preferences, and values of patients with differentiated thyroid cancer (DTC) and the physicians treating patients with DTC regarding two different treatment decisions, namely: the extent of primary surgery (low-risk patients) and the tyrosine kinase inhibitor (TKI) treatment (high-risk patients). Methods: A qualitative study was conducted. There were two physician focus groups discussing the extent of primary surgery. One included endocrinologists (n = 4) and surgeons (n = 5), and the other included nuclear medicine physicians (n = 3) treating patients with low-risk DTC. The physicians focus group discussing waiting or starting TKIs included endocrinologists (n = 2) and oncologists (n = 5) treating patients with advanced radioactive iodide (RAI) refractory DTC. Moreover, one patient focus group per treatment decision took place. In total 13 patients and 19 physicians participated. Interviews were audio-taped, fully transcribed verbatim, and analyzed. Results: Several themes were identified. Patients, but not physicians, mentioned the importance of a strong doctor–patient relationship. Patients in both treatment decision groups wanted to receive more detailed information, whereas physicians preferred providing more general information. Patients in the TKI decision group focused on palliative care, whereas physicians focused more on the effect and benefit of TKIs. Conclusions: Considering the identified themes in DTC, based on the patients’ needs, preferences, and values, enables us to improve doctor–patient communication and to develop decision support tools.
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Affiliation(s)
- Anna Koot
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
- Correspondence: ; Tel.: +31-651637081
| | - Romana Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Petronella Ottevanger
- Department of Internal Medicine, Division of Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Rosella Hermens
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Peep Stalmeier
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
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14
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Lin M, Su Y, Wei W, Gong Y, Huang Y, Zeng J, Li L, Shi H, Chen S. Extra-Thyroid Extension Prediction by Ultrasound Quantitative Method Based on Thyroid Capsule Response Evaluation. Med Sci Monit 2021; 27:e929408. [PMID: 33819211 PMCID: PMC8034237 DOI: 10.12659/msm.929408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The aim of this study was to assess the interaction between thyroid malignancies and thyroid anterior capsule by ultrasound quantification to determine extra-capsular invasion. Material/Methods A total of 145 patients preoperatively diagnosed with malignant nodules under the thyroid anterior capsule were selected and routinely examined by ultrasound. The length of the nodules (from the junction of the nodule capsule to the deepest point of the nodule, vertical diameter, V) and the distance between the nodule protruding from thyroid capsule and the highest protruding (ledge length, L) nodule were used to obtain the L/V ratio. These parameters where then used to compare the efficacy of predicting extra-thyroid extension (ETE) between L/V, the aspect ratio of the tumor, and manual judgment. Results Out of 145 nodules, there were 63 ETEs and 82 non-ETEs determined by ultrasound. Extra-capsular invasion was associated with L//V ratio, but there was no significant correlation between capsular invasion and AR (aspect ratio), age, location, or presence of clustered calcification. The ability of the ratio of L/V to predict extra-capsular invasion was superior to the predictive ability of the AR ratio. With a Youden index of 0.593, the L/V ratio was 0.2325. The use of the L/V ratio to determine the presence of ETE was superior to subjective visual judgment. Conclusions The calculation of L/V ratio by ultrasound could more precisely predict the ETE compared with manual judgment, which indirectly reflects the interaction between thyroid capsule and malignant nodules. The above conclusions need to be confirmed by a range of cases.
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Affiliation(s)
- Minghang Lin
- Department of Ultrasound, Fuqing City Hospital Affiliated with Fujian Medical University, Fuzhou, Fujian, China (mainland).,Department of Ultrasound, 1st Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Yiming Su
- Department of Ultrasound, 1st Affiliated Hospital of Xiamen University, Xiamen, Fujian, China (mainland)
| | - Weili Wei
- Department of Ultrasound, 1st Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Yiran Gong
- Department of Ultrasound, 1st Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Yinan Huang
- Department of Ultrasound, 1st Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Jinshu Zeng
- Department of Ultrasound, 1st Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
| | - Liya Li
- Department of Ultrasound, 2nd Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China (mainland)
| | - Haihong Shi
- Department of Ultrasound, 2nd Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, China (mainland)
| | - Shuqiang Chen
- Department of Ultrasound, 1st Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China (mainland)
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15
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Chen L, Wu Y, Bai H, Liu H, Li X. A double mutation of BRAF L597Q and V600E in situ and solitary brain metastasis of occult papillary thyroid carcinoma: A case report. Medicine (Baltimore) 2021; 100:e24458. [PMID: 33578538 PMCID: PMC7886408 DOI: 10.1097/md.0000000000024458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/27/2020] [Accepted: 01/06/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The rare BRAF L597Q (c.T1790A) point mutation has been previously reported in childhood acute lymphoblastic leukemia. We present the first rare case of occult papillary thyroid carcinoma with BRAF L597Q mutation in a Tibetan patient. PATIENT CONCERNS A 57-year-old male patient presented with a protruding mass on the left forehead for 2 years and numbness in the right limb for 3 weeks. DIAGNOSES The patient had a double mutation of BRAF L597Q and V600E in 2 separate lesions at thyroid and brain, the immunohistochemical staining showed that the cytokeratin (CK), thyroglobulin (Tg) and thyroid transforming factor-1 (TTF-1) were immunoreactive. All the findings supported the diagnosis of solitary brain metastasis of occult papillary thyroid carcinoma. INTERVENTIONS The patient underwent left frontal lobe metastasis (thyroid cancer) resection that involved craniectomy and artificial skull repair. OUTCOMES During the 24-month follow-up, no postoperative complications or recurrence and metastasis were found. LESSONS This is the first case of solitary brain metastasis of occult papillary thyroid carcinoma with double mutation of BRAF L597Q and V600E in 2 separate lesions reported in the literature. Our study extends the disease spectrum of occult papillary thyroid carcinoma and suggests that the BRAF L597Q mutation might play a specific role in inducing the solitary brain metastasis of occult papillary thyroid carcinoma in a Chinese Tibetan patient, but the detailed molecular mechanism remains to be confirmed by a large number of functional experiments and clinical research.
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Affiliation(s)
- Ling Chen
- Doctor of Medicine, Key Laboratory of Molecular Biology of Infectious Diseases, Ministry of Education, Chongqing Medical University
| | - Yue Wu
- Bachelor of Medicine, Oncology Department
| | - Huili Bai
- Master of Medicine, Clinical Molecular Medicine Testing Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Huandong Liu
- Bachelor of Medicine, Department of Neurosurgery, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Xiaosong Li
- Master of Medicine, Clinical Molecular Medicine Testing Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing
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16
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Spinelli C, Strambi S, Bakkar S, Nosiglia A, Elia G, Bertocchini A, Calani C, Leoni M, Morganti R, Materazzi G. Surgical Management of Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma. Experience in 25 Patients. World J Surg 2020; 44:155-162. [PMID: 31605177 DOI: 10.1007/s00268-019-05230-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To delineate the clinicopathologic features and biologic behavior of the diffuse sclerosing variant of papillary thyroid carcinoma (DSV-PTC) and to report its outcome. METHODS The clinical records of 25 patients who had surgery for DSV-PTC from 2004 to 2017 were retrospectively analyzed. Comparisons were made to similar studies in the literature reporting ≥8 cases and a cohort of classical PTC. RESULTS There were 20 females and 5 males with an average age of 23 years (range 10-39 years). Bilateral disease occurred in 80% of cases. The mean size of the dominant mass was 4.2 ± 1.92 cm. In 92% of cases, therapeutic neck dissection was performed. Male sex significantly correlated with a higher yield of positive lymphadenopathy (p = 0.045). 62% of patients had recurrent disease. Recurrence significantly correlated with male sex, the number of metastatic lymph nodes (cutoff: 22 lymph nodes), and multifocality (p = 0.044, p ˂ 0.008, p ˂ 0.003, respectively). However, it did not correlate with the age at presentation. No disease-specific mortality occurred after an average follow-up of 77 months (range 12-168 months). The two comparisons made demonstrated a statistically significant greater tendency of the current series of DSV-PTC toward more aggressive clinicopathologic features and biologic behavior. No differences in overall survival were observed. CONCLUSION The DSV-PTC should be considered a high-risk PTC that mandates an aggressive therapeutic strategy with the intent of optimizing disease-free survival.
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Affiliation(s)
- Claudio Spinelli
- Division of Pediatric Surgery, Adolescents and Young Adults, Department of Surgical Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - Silvia Strambi
- Division of Pediatric Surgery, Adolescents and Young Adults, Department of Surgical Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Sohail Bakkar
- Department of Surgery, Faculty of Medicine, The Hashemite University, Zarqa, 13131, Jordan
| | - Andrea Nosiglia
- Division of Pediatric Surgery, Adolescents and Young Adults, Department of Surgical Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - GianMarco Elia
- Division of Pediatric Surgery, Adolescents and Young Adults, Department of Surgical Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Alessia Bertocchini
- Division of Pediatric Surgery, Adolescents and Young Adults, Department of Surgical Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Chiara Calani
- Division of Pediatric Surgery, Adolescents and Young Adults, Department of Surgical Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Matteo Leoni
- Division of Pediatric Surgery, Adolescents and Young Adults, Department of Surgical Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, 56124, Pisa, Italy
| | - Gabriele Materazzi
- Division of Endocrine Surgery, Department of Surgical Pathology, University of Pisa, 56124, Pisa, Italy
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17
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Bojoga A, Koot A, Bonenkamp J, de Wilt J, IntHout J, Stalmeier P, Hermens R, Smit J, Ottevanger P, Netea-Maier R. The Impact of the Extent of Surgery on the Long-Term Outcomes of Patients with Low-Risk Differentiated Non-Medullary Thyroid Cancer: A Systematic Meta-Analysis. J Clin Med 2020; 9:jcm9072316. [PMID: 32708218 PMCID: PMC7408649 DOI: 10.3390/jcm9072316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/10/2020] [Indexed: 12/15/2022] Open
Abstract
Recently, the management of patients with low-risk differentiated non-medullary thyroid cancer (DTC), including papillary and follicular thyroid carcinoma subtypes, has been critically appraised, questioning whether these patients might be overtreated without a clear clinical benefit. The American Thyroid Association (ATA) guideline suggests that thyroid lobectomy (TL) could be a safe alternative for total thyroidectomy (TT) in patients with DTC up to 4 cm limited to the thyroid, without metastases. We conducted a meta-analysis to assess the clinical outcomes in patients with low-risk DTC based on the extent of surgery. The risk ratio (RR) of recurrence rate, overall survival (OS), disease-free survival (DFS) and disease specific survival (DSS) were estimated. In total 16 studies with 175,430 patients met the inclusion criteria. Overall, low recurrence rates were observed for both TL and TT groups (7 vs. 7%, RR 1.10, 95% CI 0.61-1.96, I2 = 72%), and no statistically significant differences for OS (TL 94.1 vs. TT 94.4%, RR 0.99, CI 0.99-1.00, I2 = 53%), DFS (TL 87 vs. TT 91%, RR 0.96, CI 0.89-1.03, I2 = 85%), and DSS (TL 97.2 vs. TT 95.4%, RR 1.01, CI 1.00-1.01, I2 = 74%). The high degree of heterogeneity of the studies is a notable limitation. Conservative management and appropriate follow-up instead of bilateral surgery would be justifiable in selected patients. These findings highlight the importance of shared-decision making in the management of patients with small, low-risk DTC.
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Affiliation(s)
- Andreea Bojoga
- National Institute of Endocrinology “C.I. Parhon”, 011863 Bucharest, Romania;
| | - Anna Koot
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (J.I.); (P.S.)
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (J.S.); (R.N.-M.)
- Correspondence: ; Tel.: +31-651-637-081
| | - Johannes Bonenkamp
- Department of Surgical Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (J.B.); (J.d.W.)
| | - Johannes de Wilt
- Department of Surgical Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (J.B.); (J.d.W.)
| | - Joanna IntHout
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (J.I.); (P.S.)
| | - Peep Stalmeier
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands; (J.I.); (P.S.)
| | - Rosella Hermens
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
| | - Johannes Smit
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (J.S.); (R.N.-M.)
| | - Petronella Ottevanger
- Department of Internal Medicine, Division of Oncology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Romana Netea-Maier
- Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (J.S.); (R.N.-M.)
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18
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Hou J, Zhang Y, Fan Y, Wu B. Risk factors of skip lateral lymph node metastasis in papillary thyroid carcinoma. Eur Arch Otorhinolaryngol 2020; 278:493-498. [PMID: 32607832 DOI: 10.1007/s00405-020-06176-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/26/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE Cervical lymph node metastasis is a prognostic factor of papillary thyroid carcinoma (PTC). This study aimed to investigate clinicopathological features and risk factors of skip lateral lymph node metastasis in PTC patients. METHODS We retrospectively reviewed medical records of patients who underwent simultaneous total thyroidectomy with therapeutic central compartment lymph node dissection (LND) and lateral LND for primary PTC from 2014 to 2019. Univariate and multivariate logistic regression analyses were performed to identify clinicopathologic risk factors for skip metastasis. Receiver-operating characteristic (ROC) curves were constructed using the results of the multiple logistic regression analysis to identify data points with the highest sensitivity and lowest false-negative rate. RESULTS The frequency of skip metastasis was approximately 12.8% (50/390). Multivariate logistic regression analysis showed that age (odds ratio [OR], 1.033; 95% confidence interval [CI], 1.008-1.059; P = 0.010), tumor size (OR 0.251; 95% CI 0.129-0.490; P < 0.001) and tumor located in the upper portion (OR 0.378; 95% CI 0.200-0.715; P = 0.003) were independent risk factors of skip metastasis (all P < 0.05). The ROC curves showed that the cut-off value of age for predicting skip metastasis was 44.5 years old (sensitivity = 0.620, specificity = 0.618, area under the curve [AUC] = 0.627, P = 0.004); the cut-off value of the tumor diameter for predicting skip metastasis was 1.05 cm (sensitivity = 0.503, specificity = 0.760, AUC = 0.682, P < 0.001). CONCLUSIONS Skip metastasis was common in PTC. The PTC patients with age > 44.5 years, tumor diameter < 1.05 cm and tumor located in the upper portion should be carefully evaluated for skip metastasis.
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Affiliation(s)
- Jianzhong Hou
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Yingchao Zhang
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Youben Fan
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
| | - Bo Wu
- Department of General Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
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19
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Feng JW, Pan H, Wang L, Ye J, Jiang Y, Qu Z. Total tumor diameter: the neglected value in papillary thyroid microcarcinoma. J Endocrinol Invest 2020; 43:601-613. [PMID: 31749082 DOI: 10.1007/s40618-019-01147-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/12/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Tumor multifocality is not uncommon in papillary thyroid carcinoma (PTC), especially in micro-PTC. However, assessing the size of the largest tumor may underestimate effect of additional foci. We aimed to investigate the effect of total tumor diameter (TTD) on clinicopathological features of micro-PTC. METHODS Data from 442 patients who underwent thyroidectomy with cervical lymph node dissection for PTC were retrospectively analyzed. Patients were classified into subgroups according to multifocality and TTD. The relationships of clinicopathological features among these groups were analyzed. RESULTS Multifocality was observed in 119 patients (26.9%). TTD > 1 cm and presence of extrathyroidal extension (ETE) were significantly higher in multifocal tumors compared to unifocal tumor (P < 0.001, P = 0.016, respectively). When comparing multifocal micro-PTC with TTD > 1 cm to those with unifocal micro-PTC or multifocal micro-PTC with TTD ≤ 1 cm, the proportions of cases with ETE, central lymph node metastasis (CLNM), and lateral lymph node metastasis (LLNM) were significantly higher (all P < 0.05). There was no significant difference in terms of these parameters between multifocal micro-PTC with TTD > 1 cm and macro-PTC or multifocal macro-PTC. The risk of CLNM was 2.056 (P = 0.044) times higher in multifocal micro-PTC with TTD > 1 cm than in unifocal micro-PTC. CONCLUSION For multifocal micro-PTC, TTD can better assess the aggressiveness of the tumor. Multifocal micro-PTC with TTD > 1 cm was more aggressive than unifocal micro-PTC or multifocal micro-PTC with TTD ≤ 1 cm.
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Affiliation(s)
- J-W Feng
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - H Pan
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - L Wang
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - J Ye
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China
| | - Y Jiang
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China.
| | - Z Qu
- The Third Affiliated Hospital of Soochow University, Changzhou First People's Hospital, Changzhou, Jiangsu, China.
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Wang X, Huang S, Li X, Jiang D, Yu H, Wu Q, Gao C, Wu Z. A potential biomarker hsa-miR-200a-5p distinguishing between benign thyroid tumors with papillary hyperplasia and papillary thyroid carcinoma. PLoS One 2018; 13:e0200290. [PMID: 30005075 PMCID: PMC6044525 DOI: 10.1371/journal.pone.0200290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 06/22/2018] [Indexed: 12/16/2022] Open
Abstract
Papillary thyroid carcinoma (PTC) is the most common endocrine cancer with a significantly increase of the incidence recently. Several cytokines, such as thyroid peroxidase (TPO), cluster of differentiation 56 (CD56), Galectin-3, mesothelial cell (MC), cytokeratin 19 (CK19) and BRAF (B-raf) were recommended to be tested by immunohistochemistry (IHC) for a definitive diagnosis, but were still limited in clinical use because of their relative lower sensitivity and specificity. MicroRNA (miRNA), as a new molecular biomarkers, however, has not been reported yet so far. To address this, hsa-miR-200a-5p, a miRNA, was selected and detected in PTC patients by in situ hybrization with benign thyroid tumor with papillary hyperplasia as a control, and the differential expression of hsa-miR-200a-5p between fresh PTC tissues and control was detected by qRT-PCR. Expressive levels of cytokines of TPO, CD56, Galectin-3, MC, CK19 and B-raf were also detected by immunohistochemistry. The correlation was analyzed by SPSS software using Spearman methods. As expected, the hsa-miR-200a-5p expressive level was significantly increased in PTC patients, compared to that of control, and was consistent with that of TPO, CD56, Galectin-3, MC, CK19 and B-raf. In addition, expression of hsa-miR-200a-5p showed negative correlation to that of TPO (rs = - 0.734; **: P < 0.01) and CD56 (rs = - 0.570; **: P < 0.01), but positive correlation to that of Galectin-3 (rs = 0.601; **: P < 0.01), MC (rs = 0.508; **: P < 0.01), CK19 (rs = 0.712; **: P < 0.01) and B-raf (rs = 0.378; **: P < 0.01). PTC and papillary benign thyroid papillary hyperplasia are difficult to distinguish in morphology, so requiring immunohistochemistry to further differentiate the diagnosis, however, for the existing clinical common diagnostic marker for immunohistochemistry, the sensitivity and accuracy are low, it is easy to miss diagnosis. Therefore, there is an urgent need for a rapid and sensitive molecular marker. So miR-200a-5p can be used to assist in the diagnosis of PTC at the molecular level, and as a biomarker, can be effectively used to distinguish between PTC and benign thyroid tumor with papillary hyperplasia.
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Affiliation(s)
- Xian Wang
- Department of Pathology, Anhui Medical University, Hefei, Anhui, China
- Department of Pathology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Shan Huang
- Department of Pathology, Anhui Medical University, Hefei, Anhui, China
- Department of Pathology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaocan Li
- Department of Pathology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Dongrui Jiang
- Department of Pathology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hongzhen Yu
- Department of Pathology, Anhui Medical University, Hefei, Anhui, China
- Department of Pathology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Qiang Wu
- Department of Pathology, Anhui Medical University, Hefei, Anhui, China
| | - Chaobing Gao
- Department of Otorhinolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhengsheng Wu
- Department of Pathology, Anhui Medical University, Hefei, Anhui, China
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21
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Li Y, Zhang Y, Xiao S, Kong P, Cheng C, Shi R, Wang F, Zhang L, Wang J, Jia Z, Wu S, Liu Y, Guo J, Cheng X, Cui Y, Liu J. Mps1 is associated with the BRAF V600E mutation but does not rely on the classic RAS/RAF/MEK/ERK signaling pathway in thyroid carcinoma. Oncol Lett 2018; 15:9978-9986. [PMID: 29805692 DOI: 10.3892/ol.2018.8561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 07/20/2017] [Indexed: 12/14/2022] Open
Abstract
In previous studies, the B-Raf proto-oncogene, serine/threonine kinase (BRAF)V600E mutation has been identified in multiple malignant tumors. BRAFV600E has been revealed to contribute to tumorigenesis by the activation of phospho-mitogen-activated protein kinases (MAPKs) and their downstream Monopolar spindle 1 (Mps1), leading to chromosome euploidy and tumor development. In the present study, the presence of phospho-MAPK and Mps1 in 161 thyroid carcinoma cases with complete clinical parameters was analyzed by immunohistochemistry, and the BRAF mutation was detected by polymerase chain reaction-direct sequencing. It was revealed that BRAFV600E was present in ~34% of thyroid cancer cases and was associated with age, clinical tumor stage and lymph node stage. However, the association of BRAFV600E with overall survival was not statistically significant. The expression of Mps1 was significantly increased in tumor tissues with BRAFV600E, however, this did not affect the expression of phospho-MAPK in thyroid carcinomas. Collectively, the results of the present study suggested that BRAFV600E may regulate the expression of Mps1 in MAP kinase independent ways in thyroid carcinoma. Therefore, Mps1 expression is associated with BRAFV600E while the upstream signaling of phospho-MAPK has no relevance. The specific mechanisms of BRAFV600E and the unknown pathway associated with Mps1 exhibit potential for further study, and provide a theoretical basis for the molecular treatment of thyroid carcinoma.
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Affiliation(s)
- Yike Li
- Department of General Surgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Yanyan Zhang
- Department of General Surgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Shuaishuai Xiao
- Department of General Surgery, Affiliated Tumor Hospital of Shanxi Medical University, Taiyuan, Shanxi 030013, P.R. China
| | - Pengzhou Kong
- Translational Medicine Research Center, Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China.,Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Caixia Cheng
- Department of Pathology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Ruyi Shi
- Translational Medicine Research Center, Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China.,Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Fang Wang
- Translational Medicine Research Center, Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China.,Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Ling Zhang
- Translational Medicine Research Center, Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China.,Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Juan Wang
- Translational Medicine Research Center, Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China.,Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Zhiwu Jia
- Translational Medicine Research Center, Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China.,Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Shuai Wu
- Department of General Surgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Yun Liu
- Department of General Surgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Jiansheng Guo
- Department of General Surgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Xiaolong Cheng
- Translational Medicine Research Center, Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China.,Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Yongping Cui
- Translational Medicine Research Center, Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China.,Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
| | - Jing Liu
- Department of General Surgery, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, P.R. China
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22
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Miccoli P, Bakkar S. Surgical management of papillary thyroid carcinoma: an overview. Updates Surg 2017; 69:145-150. [DOI: 10.1007/s13304-017-0449-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 04/09/2017] [Indexed: 01/07/2023]
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